An August report, commissioned by the Josiah Macy Jr. Foundation, details the key challenges, planning strategies, and lessons learned by 15 of the newest U.S. medical schools. The report provides an update on eight of the new medical schools, which were showcased in a 2009 report, and describes in detail the circumstances that led to the development of seven additional schools. What follows is an interview with report author Michael Whitcomb, MD, Flinn Visiting Scholar at the University of Arizona College of Medicine-Phoenix, on the key findings, how new schools can meet the challenges they are presented, and the future of medical education.

Over the past few years, several new medical schools have been established. Why? Usually the decision behind forming a new medical school is the goal of increasing physician supply with an emphasis in primary care. There is a need for more physicians and a need to increase physician supply; new medical schools can aid this process. Some of these new schools wanted to contribute to the workforce and help meet the policy position that the AAMC had put forth in 2006, which advocated for increasing enrollment in medical schools by about 30 percent.What motivates the institutions that sponsor these new medical schools? A medical school is a way to expand and brand a university, while expanding its research and science capabilities. At the time that the ideas to form medical schools were first discussed, there were only 126 medical schools in the country. Some of these universities that started medical schools happened to be in large metropolitan areas where there was no medical school, but would benefit from the infrastructure of a medical school and the resources a medical school could provide. There are some very specific challenges that new medical schools face. What are these challenges, and what opportunities do they present for “laboratories for innovation”? An interesting issue addressed in the report is the universal challenge these schools face in finding a health care institution or hospital willing to serve as a major partner. Since medical school requires that there be hands-on educational experiences provided in quality settings, there must be a health care partner outside of the university to do that. These medical schools and clinics can then work together to fill holes in patient care and research in potentially underserved areas. There are many unique ways the 15 institutions in the report formed these partnerships, which require a good clinical partner and the need for financial resources. A handful of these new schools have partnered with clinics in neighboring regions to improve quality of care. For example, Virginia Tech Carillion School of Medicine and Research Institute, featured in the report, is located in the neighboring town of Roanoke, Virginia, where the Carillion clinic is, not on the Virginia Tech campus in Blacksburg. What role can hospitals mergers play in the future of a new medical school? Looking at the academic medical center structure, it’s within the mission of the medical school to forward education, research, and improvements in clinical care. Over the past decade, we have seen major teaching hospitals begin to acquire other major teaching hospitals within similar regions. The opportunity for the medical school to have the resources for expansion and developing new programs is one of the benefits that accrues from merging with a financially strong health system. Additionally, some of the other changes in the academic environment are changes in the organization and the sponsorship of the medical schools. Probably the most recent has been in New Jersey, where the governor and the legislature took the University of Medicine and Dentistry of New Jersey – a health sciences university for the state —disbanded it, and moved those medical schools into Rutgers and Rowan University to streamline medical education in the state. How are these new medical schools tackling the challenges of changing medical education, health care reform, and the primary care shortage? New schools have the opportunity to take innovative approaches to their curriculum. Making really substantial changes in the medical school curriculum can be a complicated process; it may be best not to change the curriculum entirely but to develop innovative approaches to the existing curriculum. Many of the new schools have certainly done things that are innovative, both in the structure of the academic departments and introducing some unique new experiences. As many medical schools, old and new alike, are examining new ways to teach, what role could massive open online courses play in the role of shaping and developing the future of medical education? There are a lot of unknowns in this area. Some schools already have online course material, but few have taken an organized approach to MOOCs. Given what is happening in higher education, as well as with Khan Academy at the K-12 level, I think it will not be long before online medical school courses are readily available in one form or another. —Sarah Sonies is associate editor of Wing of Zock and an Innovation Fellow at the AAMC. She can be reached at ssonies@aamc.org. 140-character insights can be found @SSonies.

Ms. Sonies’s post reflects a school-centric view of these new schools as presented in the reports she is summarizing. What is missing is the political impetus and effect of supporters (perhaps, boosters) whose primary interest is economic development in the medical school’s locale. They look at the potential number of jobs and new sources of money flowing into their area as well as having the idea recently expressed by the Alabama Department of Economic Development that, in areas with weak economic bases, economic development is hampered by the lack of physicians and other medical resources. Another factor seldom mentioned in relation to the push for new schools, especially public ones, is that a new school will provide an alternative source of care (and the financial support for it) for uninsured and otherwise sponsor-less patients, thus relieving existing institutions of some of their cost burden.

The hope that these schools will graduate primary care oriented physicians who will establish practices and homes in rural areas 25 to 150 or so miles from the new school is likely to be forlorn. As I said in a recent comment on another blog:” Economic deserts beget physician deserts, not the other way around.” I hope Ms. Sonies will keep an eye on the new schools (now and yet to come) and report occasionally on how they are developing and what their impact on health care and the local and regional economy really is.

As a side note, the website for the Virginia Tech Carillion School of Medicine includes the clear statement that it’s sole interest is in admitting students who will “become thought leaders.” Given that, it is unlikely that many of its graduates will practice primary care among the hills and valleys of rural southwestern Virginia. Maybe the needed primary care docs will graduate from the Edmund Via College of Osteopathic Medicine (also in Blacksburg) or the developing King College School of Medicine in Abingdon about 80 miles southwest of Roanoke and Blacksburg.